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Arrythmia Flashcards

1
Q

What is ectopic beats?

A

-extra or skipped heartbeats
-they are common

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2
Q

What is the tx for ectopic beats?

A

Beta blockers

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3
Q

What is atrial fibrillation?

A

-irregular and often abnormally fast heart rate
-100+ beats per min

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4
Q

What can AF lead to?

A

Stroke
->blood may not be fully ejected so can cause clot

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5
Q

whatare the 2 types of AF tx?

A

Ventricular rate control or sinus rhythm control

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6
Q

What is ventricular rate control?

A

Using medications

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7
Q

What is sinus rhythm control?

A

Using cardioversion

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8
Q

What do you do if pt presents with life-threatening haemodynamic instablilty?

A

Emergency electrical cardioversion w/o delaying to achieve anticoagulation

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9
Q

What do you do if pt presents w/o life-threatening haemodynamic instablilty within < 48hr

A

Rate or rhythm control

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10
Q

What do you do if pt presents w/o life-threatening haemodynamic instablilty within > 48hr

A

Rate control

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11
Q

What is pharmacological cardioversion?

A

Flecainide or amiodarone

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12
Q

What should be started and ruled with electrical cardioversion?

A

start IV anticoagulation + rule out left atrial thrombus

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13
Q

What is 1st line of AF maintenance?

A

-rate control monotherapy
-standard BBlocker (x sotalol) OR RL CCB (Diltiazem or verapamil) or digoxin (predominantly sedentary pt with non-paroxysmal AF)

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14
Q

what is 2nd line of AF maintenance?

A

rate control with dual therapy (bblocker + digoxin or ditiliazem)

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15
Q

what is 3rd line of AF maintenance?

A

-rhythm control
-if >48hr risk of clotting so electrical cardioversion
-Pt needs to be anticoagulated for at least 3 weeks and given oral anticoagulation for 4 wks after

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16
Q

What drugs are used for post cardioversion tx?

how long to ant

A

SPAF
-sotalol
-propafenone
-amiodarone ( start 4wk before and continue for 12MT)
-flecainide

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17
Q

What is paroxysmal AF?

A

Intermittent episodes of AF that terminate within seven days either spontaneously or with intervention.

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18
Q

How to tx paroxysmal AF?

A

1) Standard beta blockers
2) SPAF

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19
Q

tx of episodes of paroxysmal AF?

A

pill in pocket
flecainide/propafenone PRN

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20
Q

How does stroke prevention work?

A

-Assess risk of stroke + need for thromboprphylaxis (warfarin) using CHA2DSC2-VASc
- Not needed if men = 0 women =1

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21
Q

what is CHA2DSC2-VASc?

A

C = congestive heart failure - 1
H = hypertension - 1
A2 = age 75+ - 2
D = diabetes - 1
S2 = stroke/TIA - 2
V = vascular disease - 1
A = age 65-74 - 1
Sc = sex female - 1

22
Q

+ more effective

what are the two tx of atrial flutter?

A

-rhythm or rate control
-more effective with cardioversion

23
Q

which meds are used to tx atrial flutter

A

Bblockers or RL CCB

24
Q

+symptoms

what is atrial flutter?

A

-abnormal heart rhythm (arrhythmia) which causes the upper chambers of your heart (atria) to beat too quickly
-symptoms = palpitations and feeling light-headed

25
How is rhythm control used in atrial flutter?
1) Direct current cardioversion 2) Pharmacological cardioversion 3) catheter ablation (recurrent tx)
26
What do you do if atrial flutter has lasted **>48hr**?
anticoagulation for **3wk**
27
What is paroxysmal supraventricular tachycardia?
-due to **development** of **short circuit rhythm** in the **upper chamber** of the heart -results in a **regular but rapid heartbeat** that **starts and stops abruptly** -normally tx not needed
28
What is the tx for paroxysmal supraventricular tachycardia? should terminate spontaneously on its own
1) reflux vagal stimulation 2) IV adenosine 3) IV verapamil
29
What is the tx for reccurent paroxysmal supraventricular tachycardia?
recurrent - catheter ablation
30
What is given to prevent future paroxysmal supraventricular tachycardia?
bblockers or RL CcB
31
What is ventricular tachycardia?
-**abnormal heart rhythm** or **arrhythmia** -occurs when the **lower chamber** of the heart **beats too fast** to pump and the body **doesn't receive enough oxygenated blood**
32
How do you tx pulseless ventricular tachycardia or ventricular fibrillation?
resuscitation
33
How do you tx unstable sustained ventricular tachycardia?
-direct **current cardioversion** or **IV amiodarone** -repeat current cardioversion of others x work
34
How do you tx stable ventricular tachycardia?
1) **IV amiodarone** then **direct current cardioversion** 2) if x sustained **bblocker**
35
What is the maintenance therapy for pt who are at high risk of cardiac arrest? Pharm + nonpharm tx
1) **implantable** cardioverter defibrillator 2) + **bblocker or amiodarone** (in combination with bblocker)
36
What is QT prolongation?
-**extended interval between the heart contracting and relaxing** -increases risk of experiencing **abnormal heart rhythms and sudden cardiac arrest** -can be present from birth, or it may develop later in life -usually **self**-limiting** but can be **recurrent** -can lead to impaired consciousness if not controlled **VF to DEATH**
37
What causes QT prolongation?
-**drug-induced** (amiodarone, sotalol, macrolides, SSRI, TCA, antifungals, haloperidol) -**hypokalaemia** -**severe bradycardia**
38
What is tx for QT prolongation?
-IV magnesium sulphate -Blocker x sotalol -Consider atrial/ventricular pacing
39
What is anti-arrhythmic drugs classified into?
Supraventricular arrythmias ventricular arrythmias or both
40
What is the electrical classification of anti-arrhythmic drugs?
*less clinical* 1) membrane stabilising drugs **flecainide/lidocaine** 2) **bblockers** 3) **amiodarone, sotalol** 4) CCB **verapamil, diltiazem**
41
What is the dose of amiodarone ?
200mg TDS 7DY* 200mg BD 7DY* 200mg OD DIR
42
When do you avoid amiodarone?
in bradycardia and heartblock
43
What is the S/E of amiodarone?
- **corneal microdeposits** (reversible if tx stopped) - **thyroid disorders** - hyper/hypo due to iodine - **photosensitivity** - avoid sunlight - **hepatoxicity** - liver disease - **pulmonary toxicity** - SoB, cough - **vision impaired** - blurry
44
Interactions of amiodarone?
- drugs that cause **hyperkalaemia** - drugs that cause **QT prolongation** - **CYP450** enzyme inhibitors/inducers - drugs that cause **bradycardia**
45
Monitoring for amiodarone? Including IV route
- **Thyroid functions** before * 6MT - **LFT** " " - **Chest x-ray** before tx -annual **eye exams** - **IV route** : ECG + liver transaminase
46
Which drugs need to monitored after stopping amiodarone?
*for heartblock* Sofosburvir, daciatosuvir, simeprevir, sofosbuvir, lediapruvir
47
What is maintenance dose for digoxin for AF?
**125-250mcg** Different bioavailabilites for diff formulations
48
what is therapeutic range for digoxin
0.7 to 2.0ng/ml
49
What is the toxicity range for digoxin
1.5 - 3.0ng/ml
50
What are the signs of toxicity for digoxin?
**SICK + SLOW** - SA/AV block + **bradycardia** - diarrhoea + **vomiting** - **dizziness,** confusion, depression - blurred/**yellow vision**
51
Monitoring for digoxin?
-**serum electrolytes + renal function** -take blood samples **6-12hr** after each dose
52
Digoxin interactions?
- **bblockers** - inc risk of AV block + inc plasma conc - **tricyclic antidepressants** - induce arrythmias - drugs that cause **hypokalaemia** (inc digoxin toxicity) - **cyp450 inducers** (dec) + inhibtors (inc)

CDVD (10 decks)

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